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Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse. Acta Psychiatr Scandinavia. 2006;114:3-13. 52. HET I AC U T E PS Y C H IATRI C M A N A G E M E N T typically within 24-48 hours of the abrupt discontinuation of clozapine. One previous review has suggested that the overall incidence of a supersensitivity psychosis following the abrupt withdrawal of clozapine is around 20%, but the actual incidence is probably higher than this 53. Psychotic symptoms occurring as a direct result of antipsychotic medication withdrawal can be more extreme than symptoms occurring as part of the natural course of the illness.

Moreover, the rapid shifts in fluid balance following parturition may predispose to lithium toxicity. Paroxetine Concerns about the potential teratogenicity of paroxetine are based upon three recent studies. 6))63. The second is a retrospective study conducted by the manufacturer, GlaxoSmithKline (GSK)64. 23). The most common abnormality was ventricular-septal defects, although others were described. Most recently preliminary information about the results of a new study examining data from a Swedish Medical Birth Registry have been made available65.

This latter phase appears to be mediated by the GABA mediated discharge of inhibitory interneurons. The precise therapeutic mechanism of ECT remains uncertain, however ECT is noted to engender down-regulation of beta adrenergic receptors, up-regulation of 5HT2 receptors, and enhanced activity of GABAergic neurones. In line with recent research into antidepressant efficacy, it is noted that ECT increases the transcription of mRNA coding for neurotrophic peptides such as Brain Derived Neurotrophic Factor, which mediates neuronogenesis, arborization and dendritic budding68.

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Acute Psychiatric Management by Michael Robertson


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